The number of Americans who have died from alcohol-related problems annually more than doubled between 1999 and 2017, a new study found, and that’s likely an underestimate, according to a new report.

The study was conducted by researchers at the National Institute on Alcohol Abuse and Alcoholism and published Wednesday in the journal Alcoholism: Clinical and Experimental Research.

Researchers determined that the number of alcohol-related deaths increased 51 percent over the past nearly 20 years, killing nearly 1 million Americans.

In 2017 alone, 2.6 percent of about 2.8 million deaths in the US were alcohol related. About half of these deaths are from liver disease or an overdose from alcohol or alcohol mixed with other drugs.

Researchers, however, think this number of deaths is an undercount, because while death certificates are the best way to track deaths in the US, the certificates often fail to capture the role alcohol plays in a death.

Studies show that per capita consumption of alcohol has increased 8 percent since 2000 and binge drinking numbers increased about 7.7 percent.

Earlier research referenced in the study also showed a significant increase in alcohol-related injuries. Alcohol-related hospitalizations increased 51.4 percent between 2000 and 2015.

When multiple researchers come to the same conclusion using different methods, I can tell you for certain these results are valid, said Dr. Elliot Tapper, an assistant professor at the University of Michigan.

Tapper said the increased prevalence of obesity, metabolic syndrome and diabetes in the US has made the increase in alcohol consumption much more harmful.

Tapper also said like with other deaths of despair, the number of deaths from alcohol spiked after the 2008 Great Recession.